BRIDGES

Despite new technologies and effective drugs, many patients with diabetes do not achieve optimal glycemic control.  The Diabcare 2003 survey revealed a mean HbA1c level of >8% among diabetic patients attending 22 diabetes specialist centers in the Philippines. The DAWN study has shown that psychological problems can pose barriers to good diabetes control. This project introduces a psychological intervention of family stress reduction and coping response training in the diabetes education program for  Filipino patients with type 2 diabetes mellitus. If proven to be effective, the program can be introduced to other government hospitals and modified for the community setting.

Gestational diabetes (GDM) is a strong risk factor for developing future “chronic” diabetes. GDM is common among Indian women. Limited information about lifestyle programs to prevent or delay diabetes in women with GDM is available from other countries, but their applicability in India is unknown.  We will conduct and adapt such programs to be culturally-appropriate for the Indian context and test them in a small group of patients to determine their likely feasibility. Such information will allow us to refine the program and perform a larger study to conclusively determine its generalisability, effectiveness and sustainability in urban India.

The Western Cape, South Africa has a large number of people living with diabetes and this number is predicted to increase substantially over the next few years. The majority of people with diabetes are looked after by nurses in the public sector at health centres and clinics. The quality of care is generally poor and education is performed in an ad hoc and unpredictable manner. This project intends to evaluate a structured group educational programme, supported by appropriate educational materials and delivered by health promoters who have been trained in better communication (motivational interviewing). This approach has never been evaluated in our context and if effective can be implemented widely.

The purpose of this study is to find out whether a method of nonvisual foot inspection, using the senses of touch and smell, helps people with diabetes and visual impairment to find new foot problems when they are in early, easily-treated stages. All people in the study will have regular foot inspections by podiatrists. We will look at how people feel about the method, whether they actually do it, and whether the method helps them to discover foot problems themselves, instead of waiting to have problems discovered by the podiatrist.

*Pending signature of agreement

Haiti is the poorest country in the Western Hemisphere, with the lowest government expenditures on health care. Although prevalence data are few, hypertension is reported in greater than two-thirds of adults over age 40. Poverty, lack of education, political instability, and lack of resources all contribute to an excess burden of chronic illness.  We propose to develop a diabetes treatment program which will deliver the three most cost effective interventions in developing countries: glycemic control in poorly controlled patients, blood pressure control, and foot care in high-risk individuals. Culturally appropriate educational materials will be developed and made widely available to the community.